06050095 CITY OF CUPERTINO
BUILDING DIVISIONPERNIIT dP GTORWOO ATIPN .gg.
BUILDING ADDRESS: ' MARSHALL CHARLSIE M PERMITNo.06050095
20564 KIRWIN LA
OWNER'S NAME: PERMIT ISSUE DATE
MARSHALL CHARLSIE M 05/11/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
ggg������4}}}��� BLDO it . ELECT ta PLUMB0 Ml�
jos
LICENSEDbar IamCONTRACTORS i DECrJs of ChapION Job D Ott 0
I u 1 therion 70 0 of this I am fthe Bu under provisions of Chapter 9(Commencing +s/v/�a�},{L•s�S • •
with Section 7d of of Division 3O(the Bassinets and Professions Code.AM my license u
kmuranmmderrm REPLACE WINDOWS AT $FD L 1
;�: LicenseClw Lic.g1�4 l( �1r
Da¢ COmrsemr
ARCHITECTS DECLAIATION
f 1 understand my phis han he used as public records MAY ?Z— 2006
e
al
1�
Licensed m.bYPrefesAnn Q a��
OWNER-BUIIDERDECLARATION U ■9Y�e
�21 hereby elRrm that 1 am exempt from the Contrenors License Law for the
a O following mean.(Section 7031.5,Busiams and Praresiuns Code:My City or County $4 9 6 4
SE! which mquima a permit to eomwct.alma hnpmw,demolish.rar rePat,any slrumme
SINe, Prior to its issuance.also mquims He applicant formch permit to he asigned smmem
€< that heis licensed purseammNeprovisions ofthe Contractor's Llmnselaw(Ch� 9 Sq.Ft. Floor Area Valuation
(commencing with Seedon 7000)or Division 3 of the Business and Professions Code)or
— that he Is exempt themfmm and the bask for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit aubjccu the applicant he a Civil Penalty of r Occupancy Type
our mom Nan Ove hundred dollars($500).
1,As muncr
the property,or my employees with waims
wif ill Ce the workand the swcture Is Out intended Or offered far
their WHO
wask(Sec.7W.Butancen
and Profetskns Cade:The Contractors Limns raw does Cot appy an an owrer of Required Inspections
property who build,or im prows h mean,and who doessuch wank himse3f m through his
awn employer,providd"such improvements art mtinmaled osoRem l fossale.U. -
however.the building ar improvement iamid Whin one)car afecmplWon.the owmr.
builder MB have We burden of proving man hn did ml build or improve for purpose of
ask.).
O 1.as Owner of the property,.m exclusively contracting with licensed contractors b
construct the pmjm(Sec.70th,Business and Professions Codr)The Contractus U.
cense law does Cot appy A,an owner of pmpeny who builds at Improves thereon,and,
who contracts forstch projects with amnaactor(s)licensed partisans in the Conusemes '
License law.
Cl 1 am exempt under Sec B d P C for this Monte
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby a01rm under penalty of perjury am of the fallowing deelarWans:
1 has and will maintain a Canifinte of Consent m self-hum for Wuden'sCompan-
aanon,as provided for by Section 3700 of the labor Code-far the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Toxones.An required by Section
3700 of the labor Cook.for the perfonname ofdm work for which this permit is Issued.
My Wa sCompertwioa kuurance cantct W Politytnumber are: f�
Cartier•. l CS
CERTIFICATE OFEXEMPnON FROM WORKERS
COMPENSATION -
INSURANCE v
(This section need not he compleed lime permit Is for ane hundrod dollars($100)
or less.)
1 ceniy that In the perPormenca of the work for which this permit is Issued.l shall not
employ any person in my mummer an As A,become subject to Ute Worker'CompmeWm
Laws Or California.Dam
Applicant
NOTICE TO APPr3CAN1.If.after making this Ocidncam of Exemption,you should
became subject m the Workces Compewdon provisions of the labor Cods%you most
.J O forthwith comply with such pmvkians or this permit shall be deemed Cooked.
?� CONSTRUCTION LENDING AGENCY
(--, I Mreby affirm thou them k a mnsmction leading agency for the Mdomarac of
E
vrork for which this permit Is issued(ser.307.Civ.C.)
W p Landers Name
.7. z lenders Address
U Q 1 ceNfy that I have mad Ws application and state that the.bom informadun is
LL P correct.I slime to comply with all city and county ordinances and sum laws relating m
0U building construction,and herebyauthodse representatives or this city to cnier.p.the
ahovcmemiuned property fur inspection Purposes.
(We)Agee to saw,indemnify and it=,harmless the City of Cupenino against
y Iiabilities,judgmems.cOW and expenses which may In my way acme against aid City /
U'Z In consequence or the YrmtinC of !=D '
IL
^� APP
NT
iMAN AND ILL COMPLY WITH ALL NO Issued by: Date S l
URCE GULATIONS.
st reafAppncanaO� ya r 5 M, Re-roofs
HA7wkRD0 s MATERIALS DlscLosuke Type of Roof
WIII Om.ppli 6t orf Euildinga¢upmsnorc orhWkhrurdow mamrkl
u denmtl by tM C ni Municipal Cook.Chapkr 9.13-and lire HOWh and Safety
Cade,S.-tion2553 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the apPlmrL of rutum building occupant ase equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haxardous sir contaminants a dcnwd by the Bay Area Air Quality Management all new materials for inspection.
Mantel?
❑Yea cir
I havemW the hmrdnos maicdW mqulmmcnu undcrChapmr 6.95 of the Califor-
nkHC.h"SArclyCodc.Secda 5,25533and25534.1und.ntandthouirth.building
Jess Cocu t • 4W t is my responsibility to..dry the occupantrar the
mquim On a reel rmtsaanmaf.e.nina.mofoceupmcy. Signature of Applicant Date
Owner br,112hodyn rat S-I r-0- Date All roof coverings to be Class'B"or better